THIGHPLASTY– AFTER WEIGHT LOSS –
The thigh is the part of the lower extremity that spans in between the abdomen and the knees. From the front, the thighs are separated from the abdominal region and groin area (mons) by the groin crease that extends over the hips and the back as the V-shaped demarcation in between the upper buttocks and lower back tissue. Furthermore, from the back, the upper thigh is separated from the lower buttock by a well-defined crease known as the infra-gluteal fold. The infra-gluteal fold is the continuation of the groin crease under the buttocks.
After massive weight loss, there is a variable degree of thigh tissue distortion that is dependent on the individual’s genetic predisposition, gender, amount of weight lost, current weight, muscle tone and structure, as well as body shape. The latter itself is predetermined by your genetics which essentially dictates how the fat cells are distributed within your body.
For those who have an apple-shaped body, the effect of weight loss on the thighs will be less discernible than in those patients who have a pear-shaped body with heavy thighs.
Many of our patients who have dropped most of their excess weight present with a characteristic presentation of their thigh laxity. Generally speaking, deflation of the thighs results in tissue laxity in both a vertical and horizontal (circumferential) direction. Virtually, every weight loss patient will have vertical thigh laxity. This is seen as inner thigh roll (s) that extend backwards under the buttocks, outer thigh Many of our patients who have dropped most of their excess weight present with a characteristic presentation of their thigh laxity. Generally speaking, deflation of the thighs results in tissue laxity in both a vertical and horizontal (circumferential) direction. Virtually, every weight loss patient will have vertical thigh laxity. This is seen as inner thigh roll (s) that extend backwards under the buttocks, outer thigh bulge (commonly referred to as saddlebags), numerous dimpling of the thigh fronts, as well as excess tissue around the knees.
Some patients will also experience too much skin horizontally (i.e. wider thighs) in addition to the vertical thigh laxity. In these patients, in addition to the changes noted above, the thighs are generally bigger and wider with loose skin on the inner surface of the thighs. The tissue laxity often extends below the inner knees into upper calf areas. As women have less muscular mass and more fatty tissue, the changes are typically more profound than in men. The thigh skin folds and rolls rub together and cause frustration for the patient as they are uncomfortable, cause irritation, and affect intimacy for some patients.
According to studies in 100 weight loss patients by Dr. Agha, all weight loss patients experience vertical laxity of their thighs. This can be mild, moderate or severe and affects the outer, inner, front and back of the thighs. In addition to the vertical laxity, about 40 percent of the patients also had horizontal (circumferential) laxity and excess of their thighs; especially noted in the inner aspect of the thighs.
Thus, each patient will require a customized plan, depending on the degree of skin laxity, as well as their desires and expectations.
Compounding these changes, patients often experience distortion of their lower back and buttock regions. Dr. Siamak Agha believes that it is important to look at these changes in combination with the thighs and treat these areas simultaneously.
Thigh Surgery After Massive Weight Loss
One of the most challenging procedures in Post-bariatric Plastic Surgery is thighplasty or thigh lift surgery. This is because the thigh deformity is variable; the thigh contour is heavily influenced by the adjacent regions such as the abdomen, waist and buttocks; the tissues are heavy and subject to considerable movement; and the location of the thigh incisions next to the groin make them more prone to contamination. Thighplasty refers to a number of thigh surgeries that involve removal of excess thigh skin and fat. The aim of a successful thighplasty procedure should be reduction of the thigh excess and correction of thigh descent. The new contour should follow the aesthetic features of the thigh, the scars should be inconspicuous, and the creases reconstructed meticulously. Dr. Siamak Agha prefers to use the term “thigh lift ” to denote elevation of the thigh in a vertical direction and reserves the term “thighplasty ” for circumferential (horizontal) reduction of the thigh.
In our practice we offer a number of thigh lift procedures to correct for vertical thigh or horizontal laxities. These include:
1) Medial inner thigh lift – This procedure corrects the looseness of the upper inner thigh. This is the thigh lift technique that is typically used for non-bariatric patients. The procedure however does not elevate the back or the front of the thigh.
2) Outer thigh lift – This is the most effective thigh lift technique. Often inches of outer thigh and waist tissue can be removed with an outer thigh lift. An outer thigh lift is best performed as part of a lower body lift or circumferential thigh lift. An outer thigh lift corrects for the outer thigh laxity, saddlebag prominence and waist laxity.
3) Spiral thigh lift – Pioneered by Drs. Agha and Hurwitz, this thigh lift procedure was developed for weight loss patients who require a powerful lift of the back (posterior thigh lift) and inner (medical thigh lift) thighs. Typically several inches of loose thigh tissue can be removed with this procedure from the back and inner thighs. The spiral thigh lift is more extensive than just lifting the inner thigh tissue via a medial inner thigh lift procedure.
4) Anterior (front) thigh lift – There is no formal procedure for lifting the thigh fronts in plastic surgery. However, Dr. Agha has developed a technique that offers about 1½ to 2½ inches of anterior thigh lift. Anterior thigh lift is best performed as part of an extended tummy tuck, lower body lift, or circumferential thigh lift.
5) Circumferential thigh lift – This is a combination of outer thigh lift, anterior thigh lift and Spiral thigh lift. The combination of the thigh lift procedures corrects for thigh laxity in the front, outer, inner and back. Hence the thighs are lifted circumferentially.
6) Vertical thighplasty with or without liposuction – This procedure is best used for those patients who need a reduction of thigh circumference. The procedure will remove the excess inner thigh skin through an incision that goes from the pubic area to the inner knee. Dr. Agha commonly performs thigh liposuction with this procedure to make the thighs slimmer before removing the loose skin.
Outer Thigh Lift
An outer thigh lift is the most effective component of any thigh lift procedure. In his experience, Dr. Agha has removed from 4 to 15 inches of outer thigh and waist excess tissues from his patients. The procedure is normally done as part of a lower body lift or circumferential thigh lift. Once the upper and lower incisions of the outer thigh lift are made, the excess waist and outer thigh tissue are excised over the muscle and fat. The outer thigh tissue is then partially separated from the underlying muscles using a specialized instrument known as a Lockwood dissector. The outer thigh tissue is then lifted and anchored at a higher position to the underlying muscles using multiple sutures. The waist incision is then lowered and sutured to the lifted outer thigh incision in 3 layers.
Anterior (front) Thigh Lift
An actual anterior thigh lift has not been described in plastic surgery textbooks and does not formally exists. This is another procedure that Dr. Agha has pioneered for his patients. During this procedure, incisions are made over the upper thighs, 1-2 inches below the thigh/abdomen junction. Similar to the outer thigh lift, the tissue of thigh front is loosened up, lifted, and anchor-sutured to the underlying pubic bone. The abdominal incision is then sutured to the lifted anterior thigh incision in 3 layers. An anterior thigh lift is normally done at the time of a tummy tuck or a lower body lift.
Spiral Thigh Lift
As patients lose weight, many end up with inner thigh and thigh back tissue laxity. Often patients complain about a fold of skin below the groin crease on the inner aspect of their thighs. Often, the inner thigh fold extends under the buttock crease (infra-gluteal crease) as what is known as a banana roll. Furthermore, the infra-gluteal crease can become loose. When this happens, the junction between the lower buttocks and upper thigh is lost. The buttocks and the thighs blend together, altering and blurring the shape of both the buttocks and thighs.
The Spiral thigh lift is a signature thigh lift procedure pioneered by Drs. Agha and Hurwitz in 2007. Termed the “Spiral Thigh Lift ” by Dr. Siamak Agha, this thigh lift procedure corrects for the vertical laxity of the back and inner surfaces of the thigh.
The spiral thigh lift surgery begins with an incision at the infra-gluteal crease that separates the buttock cheek from the upper thigh. A second incision is then made over the upper thighs parallel to the infra-gluteal incision. A crescent of excess tissue on the back of the upper thigh is removed through this incision and then the upper thigh tissue is lifted to a higher position and secured to the underlying tissues via multiple permanent sutures. In this fashion, the lifted thigh tissue is permanently anchored. Next, the infra-gluteal crease is reconstructed, enhancing the shape of the buttocks and thigh. Dr. Agha is able to lift the infra-gluteal fold if needed and reconstruct it at a higher position. This controls the shape and height of the buttocks.
Both of the incisions of the Spiral thigh lift are then continued on the inner thigh over the groin crease and parallel to it. Through these incisions, excess skin and fat of the inner thigh are removed, the inner thigh is lifted and then anchored multiple times with permanent sutures at an elevated position. The groin crease is then meticulously reconstructed to create an inconspicuous scar. The final scar of the Spiral thigh lift ends up in the infra-gluteal crease and the groin crease.
For patients who have horizontal thigh excess, a vertical thighplasty, which is a thigh reduction procedure is needed in order to remove the excess inner thigh skin. Many plastic surgeons call this procedure a vertical thigh lift incorrectly. The vertical thighplasty is not a lift and should not be called a vertical thigh lift.
Vertical thighplasty involves removing a large elliptical section of skin and tissue from the inner thigh. This is done through a vertical incision that runs from the groin crease all the way to the inner knees or below the inner knees if needed. The incision is placed on the inner aspect of the thighs so that it is well hidden. In this manner the thigh circumference can be reduced by about 25 to 33% in most patients. In our practice, a vertical thighplasty is the recommended procedure for about one third of patients who need a thigh contour correction. Following the vertical thighplasty, many patients elect to have an outer thigh lift together with the spiral thigh lift in order to achieve complete circumferential thigh lift of their reduced thighs.